While many key elements of fair access were not able to be assessed, the analysis found that major payer coverage policies for 19 drugs demonstrated high concordance with many fair access criteria related to cost sharing, clinical eligibility, step therapy, and provider restrictions.
During ICER’s assessment, five payers revised policies for 11 drugs in ways that bring coverage into concordance with fair access criteria, demonstrating that assessment and greater transparency may lead to positive change.
Sarah K. Emond, MPP, Executive Vice President and Chief Operating Officer:
“Payers, pharmacy benefit managers, and drug makers all have a role to plan in ensuring fair pricing and fair access to prescription drugs; while much attention is paid to the prices chosen by drug makers, this second annual Barriers to Fair Access report shows that the payer community has a critical role to play in ensuring access.
While many of the concordance levels for adhering to fair access criteria were high, we know that patients still face significant barriers to access because of policy choices made by payers. Because our annual exercise, which shines a light a small number of payer policies, leads to payers improving the fairness of their coverage policies, we are demonstrating that transparency and analysis can help the system move to what we all want – fair prices, and fair access.”
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